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TWIN EPIDEMIC

Diabetes Mellitus is a global epidemic and India is the second largest capital of Diabetes world. Diabetes Mellitus is defined as fasting blood sugar >/ 126 mg/ dl, PP blood sugar >/ 200 mg/dl, HbA1C >/ 6.5%, with or without excessive thirst, excessive appetite, weight loss etc. 95% of total Diabetes Mellitus cases are Type 2 patients where the clinical situations are characterised  by Beta cell secretory defect, Insulin resistance; where as only 5% of Diabetes Mellitus patients are type 1, characterised by Insulinopenia as a result of pancreatic Beta cell destruction.

Management of Diabetes Mellitus is considered under two headings, one is prevention or delaying the onset of full - blown diabetes and aggressive intervention  of the disease situation so that microvascular and macrovascular complications can be prevented. As far as diabetes prevention is concerned, the population at risk should be screened . This includes : (1) BMI  more than 27 kg/ m2.   (2) History of diabetes mellitus in either or both the parents, siblings.    (3) Hypertensive population.  (4) Dyslipidemic population  (5) History of coronary Artery disease of father at less than 55 years of age or mother at less than 65 years of age.

There are entities like prediabetes ; characterised by Fasting blood sugar ranging between 100-125 mg / dl, PP blood sugar ranging between 140-199 mg/dl , HbA1C ranging between 5.7- 6.4 %.  Aggressive diet and Exercise are extremely useful in these populations, so that onset of full - blown diabetes may be prevented.

The commonest comorbid disease of T2DM is high BP( Hypertension i.e BP greater than 140/90 Hg ) . 

Aggressive intervention in Type 2 DM means tight control of blood sugar, blood pressure and serum lipids. It is needless to say that aggressive management of diabetes , soon after diagnosis offers long - lasting effects. Microvascular complications in diabetes means involvement of Kidney and Retina.  Macrovascular complication means coronary artery disease, cerebrovascular disease, Peripheral arterial disease and atherosclerotic disease of abdominal aorta. 

Every one percent lowering of HbA1C decreases the incidence of both micro and macrovascular disease by approximately 30%. Uncontrolled diabetes and or Hypertension is the predisposing factor for stable angina , unstable angina, miocardial infraction, heart failure, cerebral stroke, kidney failure and blindness. Similarly patients undergoing haemodialysis also have similar background like uncontrolled twin epidemic as mentioned above except only few cases of acute poisoning and snake bite. In short aggressive management of diabetes , hypertension, dyslipidemia definitely aborts or delays onset of micro and  macrovascular complications as mentioned above.

While managing diabetes it has to be kept in mind that hypoglycaemia and weight gain need to be avoided as far as possible. Hypoglycaemia leads to cardiac catastrophe like angina, cardiac arrhythmia along with Neurocognitive decline. Weight gain of a diabetes patient increases insulin resistance and as a result of which there is lesser efficacy of a particular diabetic treatment regime. 


Dr. Debasis Saha, MD (Cal)                                                                                                                                                                                                                     

Senior Consultant in Internal Medicine & Diabetology

AMRI Hospitals                                                                                                                                                                                 

Salt Lake, Kolkata